Partnerships between the state and civil society in Brazil: case study of São Paulo state - challenges for universal access to STD/AIDS prevention in the public health system
Health Institute, São Paulo, Brazil
Background: In Brazil, health is a constitutional right and the National Health System must ensure universal access to prevention and treatment of STD/AIDS. The transfer of responsibilities in the management of primary health care and prevention of STD/AIDS for NGOs in 90s decreased the social control of public policies. This study examines the partnership between the São Paulo State STD/AIDS Program and NGOs during the convention loans for AIDS established by the Health Ministry and the World Bank (1994 - 2002).
Methods: Were developed eight interviews with managers from the three governmental levels and two presidents of State NGO Forum AIDS of São Paulo intentionally selected. Administrative papers about the agreement with the World Bank were analyzed.
Results: The partnership had increased prevention activities in the country and the State of Sao Paulo. However, it presents inequalities in different regions. The World Bank´s policy contributes to decentralization of preventive actions for NGOs. These NGOs though have developed successful experiences, have reached few people in projects with low sustainability and funded entirely with public funds. This situation difficulty the universal access to prevention in the National Health System. It was observed different views between local governments and NGOs, when STD/AIDS are not prioritized in the municipal health. Best practices were observed when NGOs were not focused only in the project financing.
Conclusions: The decentralization of Aids prevention actions to the ONGs has reduced the role and responsibilities of the public local staff, difficulting the universal access to the public health system. Currently, São Paulo STD/AIDS Program is investing on the training of local teams specialized in preventing and human rights to change this situation and increase the sustainability of prevention policy.
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